Network Operations Command Center€¦ · Network Operations Command Center (NOCC) 1050 Forrer Blvd...

Network Operations Command Center(NOCC)

1050 Forrer Blvd

Dayton, OH 45420 Nancy Pook MD FACEP Medical Director NOCC

Network Operations Command Center

An introduction to

• History and background

• Operations

• Inter-operability

• Resources

In preparation for

• GO-LIVE at Kettering: June 2019

NOCC

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Innovation for the Future

Catalysts for Change

• Growth

– ↑ Access Points (ED’s, Community Healthcare Destinations, KPN)

• Current Capacity Challenges

– Tertiary Facilities Census consistently at capacity

Catalyst for Change

Closure of Good Samaritan Hospital400 bed, urban hospital serving NW Dayton

Opportunities

Opportunity to Maximize Revenue/Resources

Improve use of Kettering Mobile Care resources

↓ LOS, LWOT’s, Diversion, Leakage

• Situation Awareness

• Easy Access to Information

• Efficient Space

• Software Solutions

NOCC: Best Practice Command Centers

TeleTracking Software Solution

https://youtu.be/K5BmPktOX1Y

Strategic Planning

Administrative visits to Carilion Clinic, Sharp Health, Ohio Health, Cleveland Clinic

NOCC Leadership Trip to Carilion Clinic

• NOCC RN Team Leaders

– Melissa, Nik, and Laura

• Mobile Care Communication Manager

– Addison Frei

• NOCC Director and Manager

– Jodie Cremeans

– Nick Squillace

• NOCC Project Manager

– Sonya Lemmerbrock

Strategic Planning

In-Depth Discovery and Design phases including all KHN hospitals, KHN Transfer Call Center, MedFlight and Kettering Mobile Care-completed by end of 2018

TeleTracking and KHN NOCC leaders do Hospital Observations during

Soin’s Discovery Phase

Discovery and Design Sessions – On the Right the RTLS

Engineers are Looking at Potential Patient Exits

Hospital Observations – TeleTracking and NOCC Leadership

Strategic Planning

• Creation of Network Capacity Management and Patient Flow Council as well as campus based councils for decision making and transparency across the enterprise

• Regular updates to Executive Finance Group, Network Leadership Group, Nursing Executive Council, and Med Exec Council

Situational Awareness:

• Centralizing Key Teams - TCC Nurses, Mobile Care Dispatch, Patient Flow Specialists(bed placement)

• Medical Director

• NOCC Team Leaders

Making all the pieces fit

Centralized IS components

– Command Center all on same phone software

– Status Indicator Lights

– TeleTracking

– EPIC

Redundancy to ensure operations seamlessly (UPS, Generator)

Situational Awareness: 200 monitors

Medical Director, Dr. Pook

TeleTracking Project Kick-off

Defense Electronics Supply Center

1050 Forrer Blvd

Gentile Air Force Base

Named for WWII flying ace

Major John S. Gentile of Piqua

Closed by Defense

Department in 1993

10 year clean-up

Gifted to City of Kettering

Construction

Weekly Construction Meetings at Site

At this meeting, we taped off the space and placed cardboard cut-outs the size of desks and TV’s to

experiment with space

More Construction

• David Nelson: Led CIP

• Kristi Tolliver: Engineer

• Nathan Verrill: Construction Fellow

• Brumbaugh Construction

• Heapy Engineering

• Ohio Valley Engineering

• Saturn Electric

Progress

One Call

Call for ALL transfers

NOCC

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Algorithm Building and TeleTracking Testing

Patient centered algorithms

IMPACT FORCE

Fall from standing or less

MVC, daredevil

sports, fall from height, penetrating

trauma, motorcycle

crash, ped vs. motorized

vehicle, other

HIGHLOW

X-ray

ATLS

CT

Vertebral Column Injuries- T/L spine

Patient movement algorithms

Transport Mode Patient characteristics Vent status

ALSparamedic

MICUParamedic

CC RNEMT

Intra-aortic balloon pumpLVAD

Art lineSWAN

Ekos catheterSheaths

Chest tube to suction

Trach and intubated patients

AC,SIMV,CPAP, BiPAP

Cardiac monitoringIV fluidsIV meds

NG to suctionBlood in process

Long term trachAssist control

Family Night at the NOCC

Finally Moved In!!

Operations Begin – January 22nd

Placing our first patient in bed in Teletracking!

NOCC Fun Facts

• 56,000 Feet of Cabling on the Command Center Floor

• 36 Floor Boxes (Data/Power Ports)

• Twenty, 86” Monitors on the Display Wall

• 40 Workstations

• All Network Bed Placement is Performed Here

• 24/7 Operations

• Internal Transportation Dispatching/Monitoring

• Internal EVS Dispatching

• Real Time System Capacity Management

Transparent movement

Tools• IPOD

• RFID tracker for discharge

• Monitoring: app or lounge

– From home or office

– To discharge

KHN TT Facilities

KHN TT Facilities

Go-livesGreene/Soin

-EVS time saved >60min

-Decreased CC bed time

Unit monitors

Grandview/Southview

-early morning ID of potential discharges

-time to inpatient bed 15 minutes

Sycamore/Fort Hamilton

-smoothest start

Kettering

-June 2019

Network Operations Command

Center

Transfers In/Out of Network

Mobile Care

MedFlight

Case Management

Social Workers

Bed Placement

Environmental Services Dispatch

Structure of Operations

Benefits of a Centralized Team

Direct Income

• Increase efficiency of access– One Call System, Faster Admission

• Increase out-of-network admissions– Create a “path of least resistance” for their

admissions

• Decrease out-of-network leakage• Better utilization of beds network-wide to

allow ALL campuses to be full• Expanded nursing home business with

one call system & transport initiatives• Decreased hospital reroute hours & ED

hold hours

Intangible Benefits• Increased Physician Satisfaction• Increased Patient Satisfaction• Creation of virtual beds through

improved throughput efficiencies• Creation of best practice, scalable

processes and procedures for throughput and access.

• Variation management in nursing practice and workload management

• Standardized nursing units

Patient Movement

Centralized Patient Flow ManagementGoal: • To implement a center for patient flow management, with a patient

centered approach and real-time visibility to Kettering Health Network bed

capacity.

Benefits: • Reduce lost transfers by using auto acceptance and auto transport launch

• Improve access to care

• Optimize available capacity

• Reduce ED and PACU holds

• Improved customer satisfaction

Implementation of Best Practices

Keys to Success:• Right patient – Right bed – Right Place – First time

• Use of ready to move

• Use of attributes

• Use of bed priorities

• Use of pending discharges functionality

Concepts In the Science of Flow

Concept 1:• When utilization is high in a hospital (Near capacity), planning for the

timely transitioning of a few appropriate patients can have a substantial

effect on delays and free up needed space at the right time.

Concept 2:• Successfully discharging at least 25% of your patients by 11AM each day

will alleviate the late afternoon crunch.

Mobile Care / Buckeye Key Points

• Centralized Transportation Dispatch

• Auto Launch of Air and Ground Transports

• Centralized Precertification of Non-emergent Transports

• Real-time GPS Tracking of Vehicles

• 54 Vehicles in the Mobile Care/Buckeye Fleet

• 185 Team Members

• 2.1 Million Miles Driven in a Year

• Standardization of Levels of Service

• Helicopter

• MICU

• ALS

• BLS

Kettering Mobile Care Update

• June 2016: New and fully staffed- 5x24 hour shifts

• April 2019 Growth

• Running 12-14 trucks

• Understaffed

– Regional/State/National Shortage

– Providers are moving to the public sector or out of industry

• NO 24-hour shifts – Safety and Retention

• Paramedic holes in schedule

Kettering Mobile Care: Where We Are

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Scheduled Floor

Graphs show that the floor trips are scheduled for late afternoon/evening and then the ED's start

to increase transfers/discharges. This causes crews to be tied up on floor discharges when the

ED's start the transfers. Floor runs are then delayed to allow for ED trips. Attempts are being

made to move the floor discharges earlier in the day to allow for more units to be available during

evening boluses.

Kettering Mobile Care

Where does that leave us now?– Extended ETA’s

– High Level of frustration

– Difficult communication

– Damaged relationship

– Compromised patient experience

How Can You Help

• Secondary EMS Providers

– Allow the NOCC to contact secondary providers

– Tell Mobile Care “no availability” then give campus an ETA

• Average On Scene Times

– ED – 0:20 *Thank You!*

– Floor – 0:45

KHN Preparedness/Event Management

Hazardous Materials

• Training

• PPE

• Highly Infectious Disease

• Chemical, Biological, Nuclear, Radiological (CBRN)/

WMD

Radio Communications

• ED-EMS

• Disaster

Event Medicine

• Equipment

• Medical

• ATV/UTVs Patient Transport/Access

NOCC

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Routine and directed review of

transfer opportunities

• Timeliness of transport

• Patient safety

• Physician capacity

• Nursing/staff capacity

• Facility capability

Midshaft femur fracture

vs.

Pulmonary Hypertension

Case review: 80 y.o. female

NOCC

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Interested in more?

• Tour

• Solutions

• Chart review

nancy.pook@ketteringhealth.org